HomeMy WebLinkAboutBuilding Permit # 10/11/2016 BUILDING PERMITpFwork
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TOWN OF NORTH ANDOVER
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APPLICATION FOR PLAN EXAMINATION "
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Permit Nom l7 Date Received 4_067R°�R�TEv
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Date Issued:
IMPORTANT: Applicant must complete all items on this page
LOCATION 2A —
Print
PROPERTY OWNER M c- Vel i
Print loo Year Structure yes no
MAP PARCEL: Ck ZONING DISTRICT: Historic District yes no
Machine Shop Village yes no
TYPE OF IMPROVEMENT PROPOSED USE
Reside tial Non-.Residential
❑ New Building One family
Ll Addition Li Two or more family 11 Industrial
Iter tion No. of units: ❑ Commercial
L�Lepair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
;, �,�.ar' _':_,' '. ��� F. "�Cw-. ';✓'.s,.,�. r;1.,-.. -�,,..0 .kz_,-,,��"�� ..� ""° ✓„� ,„ a� �.,�', ;�'.�M.,,Fz ,,-., c..-s�. y��a '; c u, ���, ��A3r r...`
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DESCRIPTION OF WORK TO BE PERFORMED:
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Identification- Please Type or Print Clearly
OWNER: Name: ixj �y (\Ur Phone: 2�
Address: 1A ftDne
Contractor Name: �C ti .m Phone:
Email: i S � r\
Addres q
Supervisor's Construction License: -� Exp. Date:
Home Improvement License: Exp. Date: ty
ARCHITECTIENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE.BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F_
Total Project Cost: $ � � � I ' FEE: $ ----
Check No.: Receipt No.: 310 i
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
............
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Town of _ �f: bAndover
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No. ��_ ao
h ver, Mass - /�of
COCM1CnlW,Cn 4
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BOARD OF HEALTH
Food/Kitchen
PERMIT. T LD Septic System
THIS CERTIFIES THAT ........... .......... .. . ... . BUDDING INSPECTOR
ee��t
has permission to erect .................... I.;.... buildings on .�......AN&?....A.4............................... Foundation
Rough -
to be occupied as ............
.......'lR.����.�.�.........�.�.�����.��.....���.11�......~.....��w�.... Chimney
provided that the person accepting this permit shall in every respect conform to the terms of the application Final
on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and
Construction of Buildings in the'Town of North Andover. PLUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
Final
'PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR-
UNLESS C SRCTI® T Rough
. Service
........... .. ... ... ..... ..................,................
Final
BUILDING INSPECTOR
GAS INSPECTOR
OccuRancy Permit.required to Occupy Building Rough
Display in a Conspicuous Place on the Premises — Do Not Remove Final
No Lathing or Dry Wall To Be Done FIRE DEPARTMENT
Until Inspected and Approved by the Building Inspector. Burner
Street No.
Smoke Det.
4
! tSadaral Ip�
RISE Englueelnillg taagsatra0ot►tto mea
MA CwAM twRegles>elfan No 1209P
RISE ':. A dirlsiaa atTbteisals En�atpiu8
ENGINEMNG Y� CMPV Ad�Qty,MA 110000
401_1 401-z23-la3a CONTRACT
PROORAM
CMA-HES FGRWWAAS
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Megan Warner 1 "� (978)258.7885 07/11/2016 423706 00004
�1WON
29 Anne Road i 29 Anne Read
North Andover,MA 01North Andover,MA 01845
JOB DESCRIPTION
HFAL7H&SAFM.Weaftb2ft work cm=poowd wiftl dw imAdcal draft issue is fixed.
$0.00
AIR SEALING:Provide Mar and maWds to sad am ofyow lmme against wastafizl,am=sir tedmga. M work wM be
pm6`er=d in 000mt**b ft um ofspedW soots sod diad taste to asset that your hams will be left with a hed*M lend of
*anhwip and Wow a&q Wkr.NkUrlds to be usad to seal your ho=coo laduda cmft fo ms end other probm Pmtta y
on tar sassing bola&airlealmgcto mica,baseman,attached pmWs ass other omhaated mine(wb dews we pmt 0at«ft
addsessed.)TWs wig mgtdtm(8)ww"hours.A mductkm 0a cubic fed permiatus(oft)ofair fid b ehm will omw.but the acetal
numberof efia is not
At tits complatin of the weadmiadw walk,and at no additlund oust to the homeowcer,a fail blower door aadlor can nation
safely analysis wM be cont buft3 by the sab4omactur to awe the sift offt h&orairgm ty.
$68000
MP.MMMO AMM (4)wodit haus.
$34{L00
DA1►f&M:Pmvide labor and materials to instep a l2"low of R-8 unfaoed ffttWm Laos to(60)sgaam feet for dammbm
paqmm
5123.00
ATTIC FLAT:Provide labor and mataids to ioatell a 6"bW of R-21 Cuss i Cdhdosc added to(1088)square fog of open aide
SPM
$1,370.88
KNEE WALLS:Provide loner ad materials to two 2" FSK faced semirigid fiber8tsas board bsstdat m to(220)sgnsorc fiat of
lmoeavetl tat:a
3770.00
ATM AClC6S ,.PmWAlaborat►dma*WstoimlaatboLadcof(1)lwAmvdhwith2"daidThammbmd.Weat4seratr ft
per•
$60.00
Am At7cEss:Ptrovide bihor sad materials to fasidate the back of the ante door wi*r rigid 7b=me board sad seal rho duo='s
ed8e with weatborsdimb*to restrict air ieakw
• 573.91
VE{4TII.AMON:Prwride Idw and asst WS to install veatilat M dtutes 5r(26)rafter bays to mauttm air Sour.
552.00
ll�10ENPfiVR RISE Eogi wip apply ap> 1a.eligible to this ooa#act You vdU o*be bplcd the tW m wit
ctorcmly.fbr elhok menu.columable Gan offhm as h%mivaaf 75%coatto csooced SZOM pa cstasdsr year,and an itxutdvo
of lW%Aw the Air Seaga$measum up to the*9 5680 mil on aadrriooal 3340 ifsab$s walustiftd by the adita.
FOR A Llnmr W TIME.Columbia On will also ottr on addWona13100 im ative eowmb the wcWmizdw work cudhwd in alas
proposal.T*ipe W Sher lmasdve fs available to homeowacrs who have had their Con nW Gas fmatc amw audit bdm July
31,2016. A dgaod pmpaW fm t aWmimtirm seeds to be submlttod by Aup st S.2016 and work mug be eonVhftd by$a mid a'
RISE Englacering rm ft also
RI
A dtvl =of memb Fvatufag 9A CeatnsetorftSbbWW tato IWO
S C0mpmWAddf*ff4awmA0m
ENGINMIN 401-M12M FAX 401-ID-11M CONTRACT
ft" 2
PROGRAM
CMA-MSA SW
ammmUmIrAm
Now am
m%ft Warner (978)258.7885 07/11/7016 423706 40004
29 Anne Road 29 Acme Road
North Andover,MA 01845 North Andover,MA 01845
JOB DESCRIPTION
30,2016.
For dm aft and health ofyour home's indoor air quality,we will be oorWm ft a blower door diagnostic ofthe evadable dw flaw in
year hemi both before the work 6 bvm.and after the wit work is a mVi te.We wal 41W eondw a fnli aneunwa of
the ocatbuW*n sd*of yoar bo ia0 system and water beW.Ths hes a value of 990 and 6 at m Dost to you. The mmd=m
Wowdit inoadive for ail mmms.iodWbg alr sm tq{.Is$3,210
The Pa mit wi11 be secured by rho lasnfWm comrade/,at no adMoad com it is the 1z=wmc'a respmiisithy to doss oat this
Ppb by &*why at the cmuodiaa offt wort.
990.00
Total: $3,811 .79
Program incentive: $3,992.34
Customer Tcal: $BETA$
vm nrs�t tttrtea+r ro tit umtvtcss.catu+t.ete at At�eaar�e tfiattt�ea+ts ttea�ta.tote Etta ett�t op
*"Five Hundred Fifty-Seven&45MOD Qo#Mrs $WAS
to ,°�"irrmtm�'� �eraw�' tam,�aseaeeaum� w°Nma�
W t1Kilr is ARE aPACO
L= wow,.,
ttottattaaooK►ascTtreasarnmiusarevwrrwarraciarr�aoamr cn�awaocst�wps 7112(2816
ngeavrcw,mr.irttcn avam�anormam
30 nava aaav �p�°r�eieae� ° a' nc
OWNER AUTHORIZATION FORM
iVjE2aat-i -..k1aKvifrr'
..01, (Owner's Name)
owner of the property bcated at
C? ,V
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,L
(Pmparty Address)
(i e,,/
, ono , GS
(Property Addrew)
hereby authorize
(Sub=ftctor)
an authorized subcontractor for RISE Engineering,to act on my behatf to obtain a building
permit and to peftim work an my property.
Owner's -Snature
Date
ACf;PRt3 CERTIFICATE OF LIABILITY INSURANCE
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLOER.THIS
.CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POUCIES
BELOW, THIS CERTIFICATE OF INSURANCE OO£S NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER{S),AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder 7a art ADDITIONAL INSURED,the peOCYNO must be endorsed. If SUBROGATION is WAIVED,subjeu to
the terms and conditions of the oicy,certain policies may require an andorasmeM,A statament on this certificate does net eanfer 4obts to the h
asrdil"te holder In Ileu of such endorssme a.
PROWMCONTALT
Kala Da h f
MARTIN J.CLAYTON IN$URANCE AGENCY INC 'HOME 413 530.0804
;_kde chn,com
1644 NORTHAMPTON ST.,RTE 5 elalraa a AFf Qe+s e e Ate
HOLYOKE MA 01041 m1aLlaaa A: ACADIA IHS CO 31325
° WOUKE s:
GAUTHIER INSULATION INC
wauRaR at
PO BOX 344
LvsuaeR
IPSWICH MA 01S38 MOM
COVERAGES CERTIFICATE NUMBEW 76783 REVISION NUMBER:
THIS IS TO CERTSFY THAT THE POLICIES OF INSURANCE LISTED tS OW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INOK:ATEO, NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONIIfhON OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS `
CERTIFICATE MAY SE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED SY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, i
EXCLUSIONS AND CONOITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED nY PAID CLAIMS,
xlaaPwauRANu eQU Mefe 'I Cliffe
COMMaacIALOErICI1M WgILrrY EACHCCCURREMX L
CLMNISArADE n OCCUR 'D S
MEDSkP Erse .m 7 II
N/A PEKSWN SAWINIURY 15
OL•ML AOGREOATE LIMRAPPLIEe PeR: GEF@RAL A9DREUTE I a
Ej miryF -T F7 4-c LP,R_OWIuc�u,.(AMPIDPACA S
!—AUraµpenAtJADaLT' t
f hANY"UTn 86°RY WURY{Po�penWt} 8
ALLCwNeD aCHE'DLa,Cp
AU304 AL1i09 NIA t 0001LY W W[V OW SSe4YM1r) S l
NONLWNEO
NR{SDAUTOS JAUTOH t I
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i VLRRaLL,A Wtl 5OCam &ACM OCCURRENCE S
a%Catl7 LuA" CLMMS-MADE NIA AaeREWT[
QTENnON = i
MIOAaE"COIINp"$,%MK
AHQFMPLOYDWLLkwLffy Ylk
ANYPRCPRrerOA7ARTN R/EyECtIrN- F.L.EACH AWDENT S 590.000
A {Na F MRexuuoEo, wA;Nu arA MAARP300327 10130/2015 1 O14(ml6 j
Illf' I e.L.°ISWR-FAEMPLoYE s 500000
a aDON�` RA p.u,. !S.L.rnasASC.voI-Icr UNLIT 590000
NIA
DEaORIPY}pN Or oYCrLaYgke fLOCATOILY lVaNlCLea GCCRQ ref,A001VHrllLmuYs arNrdilkil BOblimhodit AmaPg41"11 0
WOrkOre Comperlasllon benefits will be paid to MasaachueFda employees Only.Pursuant IQ Endorsement WC 20 03 OB B.no aulhofketion is given to pay 1!
claims ror b°nafte to ampidyees in states other inen Massochus°Its Ifthe Insured hires,or has hired arose employees outside of Massatlwaelts, 1
Thiscara4€ceto of Insurance shows the pol!Ly Inform an the date that lhfs cortifloste was issued{unless the expiration date on the above pasty precedes the
Issue date Of this certificate of insurance). The atasm III 9"zannage Can be morsitorad daily by accessing the Proof of Coverage•Cdvamp Ven Wion
Soarch tool at www.mass.g°vMudMwrkan•.=pensaHomgrmAstlgatbne.
CERTIFICATE.HOLDER CANCELLATION-
SHOULD ANY OF THE ABOVE DESCRIBED POUCH$QE CANCE"ED BEFORE
THE EYMPATION DATE THEREOF. NOTICE WILL BE DELIVERED IN
Town Of North Andover ACCORDANCE WITH THE POLICY PROVts10kS.
1200 Osgood Street
AUTHCRiaQ RlPREaeNT►TIYE
Nash Andover MA 01845 NNWM 1Cra�y,CPCL1,Vice President-Residual Market-WCRIBMA
0+1868-2014 ACORO CORPORATION.All flights reserved.
ACORD 26(2014191) The ACORD name and toga are registerad marks of ACORO
The Crrtrttttonweidth of.t'lassac:htactts
—� Departmeltt rrf Industrial Accidents
C1ffice of Iirvestigaiians
0 Wo, I Congress Street,Suile 100
won,AN 02114-2017
-" �^ * }"k'ls>.17i11.1.5.,1,fi(13'(fil#
IVorkers' Compensation Insurance Affidavit: Iiiiilders;(.'t)ntractor-,/Electrieia"% Pluntlacrs
Applicant Information Please Print Legibly
Name Stitt irlr Et.)r;.ltiyr;:tiflsl'[n&€ i,4,I on
C`i,state"7ip: 1 \,Q► __� 1 t t Pit+ l � 1`� �# a '#
._ _
.ire you an crnpirvyeh Check We appropriate bm: �j F)PE(of project irequired):
I x I €n a cntplc3E'cr ti4itlt d. ® 1 am a crlcrul cortt-ailw,and f II
Hate hirci €tri subv inr nor [ ® \�Et �oRSrr'.r�iian
i-nlplus�ce-ti t, �u11 n€1��ur L€�ar titrtc¢." �
I wn a wk 1?rUprt uw mpJrwa- Its wd on dw allad d WL Rani )ding
ship and I�te�r nes ctwplo;�e�� .I(rese..*t:h-Cillaraett3r.�11'c:�c' I 1. Demoltrion
empkjoes and h,:t: stvrl:rra`
;;"airl;in:'. QW Me m arta Cal�aciia°. ittiklin <relr9i iilry
[No worker;' coFE1'f_rTrlur-InCL' Cling ir�i Lirance.'
0 W. Ilr,. a corpor.t n inn its = (.1.C] I_lc>:.m al rcpwaN or adilitions
re�riired.f ilor
i r s g ' 3 offii,:c , ha—, cA4 ii jsed Mar i �.I. Pltilt bm? ,. rC Dairs lar gad:iiiti;oas
I r v7�i hlarTti:u;4ner c4i3f tt a1.�t�e,rk 1
m1'sclf jNo"ork- rs' comp. rilsh; of c,�e pliim t3 Y '061-
1__® ltui;f rei+;tir
insurincc rciluirci�_� ' c. 152, 51(-t),wK wkt liotr rio
c!t'¢plugcs. [:e'cf Ox`tiritt'?s•
eiFn7Ls. irt�iis1¢1tl�s'. f:yt3rrCE1.�
°Aq a<<WE. M AMAW6 KA 0 nit A;Q or;ke 1-Lahr., •1 ,5; Ise. WOWWF W t- a PAU i„r=%`11
i$i�11}cr�.r. a`m.}lh rs:thTs s 1i a+i'.!_d.c i%2v t v,,, d}a_.'-ISI t,c 3,; :a",.-;,.r.:a y"1n3:aa Wm"n M A Am n TW
C onll :lilr?CII,ii 61,CE k F171 No "W im R.=0 0wr,ay 4W tM?i},:f.,A"a nc-I .:.z MG,'i_3..'.xWO Jl:r'_one 55}itiIn a ilii',1"a:i o;•II C'
hm
S€3r §, .r-w'171€-3:Im:t;tic t'•:..1:
{unt erre etnpina�r'r that is priei•idiea,;r storkcrs'cnttrpnnticrtiun itr.krrrurvcc°,/,r rtrr tmlrlo3•e�c�s. t3elcrTT•i.s the°pniie.t•rttrd joh sihp
ira)iertrtatiarr,
Its
otrao c�eQ t'� A 4nLbwv �1 Oq�
Job Site. Address, —-- - �art �ta1c L1Iv"__._..�_._ ---
much :a corny of the workers' compensation polic) cicclaratiun Dare(shoirin-,the pcilicE number and e piration date),
failure o sccLt e coverage as icgWrcd under Sedi 3n 25A t10W..c. 152 win lead to do It111#'1SSIwn of CtSrt31nM llctttk4s f1'a
fim up tel ISIONTO 8.W orNii'Vur ?r3lprisonalcm a5 %;,A Ji,ci%il ikirYii hs err Liw iii n of i y1 OP NVORK ORDER and a fine
331 'jp 1s}sl5o no'j d" a aintil he "(>1ti1w. He a�khm 111w.a nTy o ds h[,ilunem 3tt 11- be Ramar'ded to the Oke of
Inves1igmions of the D14 Ar insuranec Co%vragv vi'TLacalum.
I du here v cernhv under the paha and pettahbs of perjury that the itijorrncrtion provided above is true and correct.
Orr v�itur� ..
Official use onty, Do not tvrite in this area,to be conopleted kv city or tomo r,ljicial.
City or•rown:
Ksuitkg Authority icircte one€:
1.Board of health 2.Building Department 3.['ily Toren Clerk 4.Electrical Inspector 5.Plumbing Inspvetirr
6.01her - _ ................__..___.
C.'ontact Verson: -- — 1'harrte rt:
... .. .. ........ .... ............ .........
/ y
Office of Consumer Affairs and Business Regulation
10 Park Plaza - Suite 5170
Boston, Massachusetts 02116
Home Improvement , '-Ctor Registration
Registration: 173410
Type: Individual
LQ
Expiration: 1 011 1201 8 Tr# 291320
KURT GAUTHIER
KURT GAUTHIER r
119 COUNTY ROAD
IPSWICH, MA 01938
Update Address and return card.Mark reason for change.
SCA 1 &3 20M-05111
Address C Renewal FlEmployment ❑ Lost Card
C-�/ftG'�Qp��r184a2Weau�a�C�'!i(.aa6�
Office of Consumer Affairs&Business Regulation Registration valid for individual use only before the
HOME IMPROVEMENT CONTRACTOR expiration date. If found return to: i
Reglstaatlont,
r X3490 Office of Consumer Affairs and Business Regulation
Type:
Explratl%=_. &-20118 Individual 14 Park Plaza-Suite 5174
Boston,MA 42116
KURT GAUTHIER
KURT GAUTHIER
119 COUNTY ROAD L .c<r i !C.J C
Departg.jent O.f
Board ofamUmRcqu�atjna
License- CSSL-1025.62
KURT R GA UT"WR
P"0.A!344
IPswich MA 019JR { \.: / {
Expsfavon
OWN2017
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